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Introducción. Las cardiopatías congénitas (CC) en Chile corresponden a la segunda causa de muerte en menores de 1 año, requiriendo cirugías paliativas y/o correctivas el 65% de estas. En el post operatorio frecuentemente se utiliza ventilación mecánica invasiva (VM) y succión endotraqueal (SET) para remover secreciones. Sin embargo, la kinesiología respiratoria (KTR) ha mostrado mejoras significativas en la distensibilidad toracopulmonar (Cest) y resistencia de vía aérea (Rva) en otros grupos de usuarios pediátricos y adultos en VM. Objetivo. Comparar los cambios en la Cest y Rva en usuarios pediátricos en VM post cirugía de cardiopatía congénita (CCC) sometidos a KTR versus SET exclusiva. Métodos. Revisión sistemática de estudios publicados en bases de datos PUBMED, PeDro, Scielo y Google Scholar que comparan el uso de KTR ó SET sobre los cambios en mecánica ventilatoria en usuarios pediátricos en VM post cirugía de cardiopatía congénita, limitados a inglés, español y portugués, excluyendo a sujetos con traqueostomía o con oxigenación por membrana extracorpórea. Se utilizó guía PRISMA para la selección de artículos. Se revisaron 397 artículos y se seleccionó 1 artículo extra de los artículos sugeridos. Se eliminó 1 artículo por duplicidad. Por títulos y resúmenes se seleccionaron 2 artículos, los cuales al leer el texto completo fueron retirados debido a que la población no correspondía a cardiópatas. Resultados. El final de artículos seleccionados fue de 0 artículos, debido a lo cual se removió el operador Booleano "NOT", y se removió la población de cardiopatías. De este modo quedaron 2 artículos seleccionados para la revisión cualitativa final donde se compara KTR versus SET, y KTR en kinesiólogos especialistas y no especialistas, mostrando ambos aumento en la Cest y disminución de la Rva a favor de la KTR, hasta los 30 minutos post intervención. Conclusiones. No se encontraron artículos que demuestren cambios en Cest y Rva con el uso de KTR + SET versus SET exclusiva, en usuarios pediátricos ventilados posterior a CCC. Con la remoción de filtros seleccionamos 2 artículos que demuestran aumento de Cest y disminución de Rva en sujetos pediátricos en VM, uno comparando con SET, y por grupos de especialistas y no especialistas en respiratorio. Se sugieren estudios primarios para evaluar los efectos de esta intervención en esta población.
Introduction. Congenital heart diseases (CHD) are the second general cause for children death under 1 year. In Chile, approximately 65% CHD need surgery, could was palliative or corrective. In the postoperative period, invasive mechanical ventilation (MV) is frequently used as a life support method, but it is associated with complications. Tracheal suction (SET) is regularly used to remove secretions; however, respiratory chest physiotherapy (KTR) has shown significant improvements in thoraco-pulmonary compliance and airway resistance in other groups of pediatrics and adult's users in MV. Objetive. to compare changes in thoraco-pulmonary compliance and airway resistance in pediatric subjects under mechanical ventilation after congenital heart disease surgery comparing chest physiotherapy and exclusive tracheal suction. Methods. systematic review of studies published in PUBMED, PeDro, Scielo and Google Scholar databases who compares KTR or SET use on changes in ventilatory mechanics in pediatric users under MV after congenital heart disease surgery, limited to English, Spanish and Portuguese languages, excluding user with tracheostomy or extracorporeal membrane of oxygenation. It was use the PRISMA guide to articles selection. A search was carried out, with a total of 397 articles reviewed (English: PubMed = 3, PeDro = 8, Scholar = 383; Spanish: Scholar = 3, Scielo = 0; and Portuguese: Scielo = 0). One extra article was selected from the suggested articles, and 1 article was eliminated due to duplication. By titles and abstracts, 2 articles were selected, but the population did not correspond to heart disease. Results. the final selected articles were 0 articles. By this reason, it were removed: Boolean operator "NOT", and congenital heart disease population. Thus, 2 articles were selected for the final qualitative review where it was compares KTR versus SET, and KTR by specialist and non-specialist. Both articles shown improvement in compliance and resistance until 30 minutes post intervention. The CC population was in a 40 to 60% range in both studies. Conclusions. it was no found articles that demonstrate changes in compliance and resistance in the airway with the use of KTR + SET versus exclusive SET in pediatric users after CCC connected to MV. After filter remotion, we found 2 studies shown improves in increase compliance and reduce resistance in pediatric user in MV, ones comparing with SET, and the other one comparing between specialists in respiratory pediatric physiotherapy and not specialists. It suggests to made primary clinical studies about this intervention in CC population.
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Introducción: La neumonía adquirida en la comunidad (NAC) es una infección respiratoria en la cual es frecuente observar la indicación de fisioterapia respiratoria (FR). Sin embargo, en la actualidad las recomendaciones respecto a su uso en NAC son controvertidas, no existiendo evidencia que respalde su uso y permita conocer su real alcance. Objetivos: Revisar la evidencia respecto al impacto de la FR en pacientes adultos que cursan internación por NAC. Resultados: 5 estudios cumplieron los criterios de inclusión de esta revisión. Las maniobras de FR incluyeron ejercicios respiratorios, drenaje postural, percusión, vibración, espirometría incentivada, resistencia espiratoria, asistencia torácica durante movimientos respiratorios, tos dirigida y presión positiva intermitente. En los estudios incluidos la FR no disminuyó la mortalidad ni mejoró los valores espirométricos en los pacientes con NAC, así como tampoco los días hasta la curación ni la estadía hospitalaria. Respecto a los costos, el uso de FR en pacientes con NAC presentó un incremento significativo de los mismos. Conclusión: No hay evidencia que respalde el uso de manera rutinaria de FR en los pacientes adultos con NAC. Consideramos que se requieren de futuras investigaciones que permitan conocer el impacto de la FR en pacientes adultos con NAC, así como establecer consensos respecto a su indicación, selección de maniobras, estandarización de técnicas, tiempos y dosificación.
Introduction: Community-acquired pneumonia (CAP) is a respiratory infection in which the indication for respiratory physiotherapy (RF) is frequently observed. However, currently the recommendations regarding its use in CAP are controversial, and there is no evidence to support its use and allow us to know its real scope. Objectives: To review the evidence regarding the impact of RF in adult patients who are hospitalized for CAP. Results: 5 studies met the inclusion criteria of this review. RF maneuvers included breathing exercises, postural drainage, percussion, vibration, incentive spirometry, expiratory resistance, chest support during respiratory movements, directed cough, and intermittent positive pressure. In the included studies, RF did not reduce mortality or improve spirometric values in patients with CAP, nor did it improve days to cure or hospital stay. Regarding costs, the use of RF in patients with CAP presented a significant increase in costs. Conclusion: There is no evidence to support the routine use of RF in adult patients with CAP. We believe that future research is required to determine the impact of RF in adult patients with CAP, as well as to establish consensus regarding its indication, selection of maneuvers, standardization of techniques, times, and dosage.
Assuntos
Modalidades de FisioterapiaRESUMO
Introducción: La neumonía adquirida en la comunidad (NAC) es una infección respiratoria en la cual es frecuente observar la indicación de fisioterapia respiratoria (FR). Sin embargo, en la actualidad las recomendaciones respecto a su uso en NAC son controvertidas, no existiendo evidencia que respalde su uso y permita conocer su real alcance. Objetivos: Revisar la evidencia respecto al impacto de la FR en pacientes adultos que cursan internación por NAC. Resultados: 5 estudios cumplieron los criterios de inclusión de esta revisión. Las maniobras de FR incluyeron ejercicios respiratorios, drenaje postural, percusión, vibración, espirometría incentivada, resistencia espiratoria, asistencia torácica durante movimientos respiratorios, tos dirigida y presión positiva intermitente. En los estudios incluidos la FR no disminuyó la mortalidad ni mejoró los valores espirométricos en los pacientes con NAC, así como tampoco los días hasta la curación ni la estadía hospitalaria. Respecto a los costos, el uso de FR en pacientes con NAC presentó un incremento significativo de los mismos. Conclusión: No hay evidencia que respalde el uso de manera rutinaria de FR en los pacientes adultos con NAC. Consideramos que se requieren de futuras investigaciones que permitan conocer el impacto de la FR en pacientes adultos con NAC, así como establecer consensos respecto a su indicación, selección de maniobras, estandarización de técnicas, tiempos y dosificación.
Introduction: Community-acquired pneumonia (CAP) is a respiratory infection in which the indication for respiratory physiotherapy (RF) is frequently observed. However, currently the recommendations regarding its use in CAP are controversial, and there is no evidence to support its use and allow us to know its real scope. Objectives: To review the evidence regarding the impact of RF in adult patients who are hospitalized for CAP. Results: 5 studies met the inclusion criteria of this review. RF maneuvers included breathing exercises, postural drainage, percussion, vibration, incentive spirometry, expiratory resistance, chest support during respiratory movements, directed cough, and intermittent positive pressure. In the included studies, RF did not reduce mortality or improve spirometric values in patients with CAP, nor did it improve days to cure or hospital stay. Regarding costs, the use of RF in patients with CAP presented a significant increase in costs. Conclusion: There is no evidence to support the routine use of RF in adult patients with CAP. We believe that future research is required to determine the impact of RF in adult patients with CAP, as well as to establish consensus regarding its indication, selection of maneuvers, standardization of techniques, times, and dosage.
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Resumen El fisioterapeuta a lo largo de su profesión ha ampliado el espectro de intervenciones y escenarios de desempeño, siendo uno de los más recientes el abordaje en la unidad de cuidado intensivo neonatal. Recientemente se han reportado en la literatura diferentes estrategias de intervención con el objetivo de lograr un desarrollo adecuado del neonato, tales como masaje, estimulación kinestésica, educación en el programa madre canguro, y maniobras de tórax. El objetivo del artículo fue revisar la información actual proveniente de la evidencia científica disponible sobre estas diferentes estrategias de intervención aplicadas en la unidad de cuidado intensivo neonatal, por lo que se realizó una revisión bibliográfica de los artículos encontrados entre febrero y agosto del 2019 en las bases de datos PUBMED y SCOPUS. Se obtuvieron 40 artículos que cumplieron los criterios de selección y que se incluyeron en la revisión. Finalmente, se concluye que estas estrategias de intervención fisioterapéutica contribuyen al logro de un desarrollo integral adecuado en el neonato. MÉD.UIS.2021;34(1): 63-72
Abstract The physiotherapist throughout his profession has broadened the spectrum of interventions and performance scenarios, one of the most recent being the approach in the neonatal intensive care unit. Recently, different intervention strategies have been reported in the literature with the aim of achieving adequate development of the newborn, such as massage, kinesthetic stimulation, education in the kangaroo mother program, and chest maneuvers. This article aimed to review the current information from the scientific evidence available on these different intervention strategies in the neonatal intensive care unit, so a bibliographic review of the articles found between February and August 2019 in PUBMED and SCOPUS databases was carried out. 40 articles which met the eligibility criteria were obtained and included in the review. Finally, it is concluded that these physiotherapeutic intervention strategies contribute to the achievement of an adequate integral development in the neonate. MÉD.UIS.2021;34(1): 63-72
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Humanos , Recém-Nascido , Terapia Intensiva Neonatal , Estimulação Física , Terapia Respiratória , Método Canguru , MassagemRESUMO
Primary ciliary dyskinesia is a rare autosomal recessive disease with compromised mucociliary drainage. Among the most commonly recommended non-pharmacological therapeutic strategies are secretion drainage techniques. However, the evidence for the use and effectiveness of these techniques is low, and they are generally based on extrapolated evidence of cystic fibrosis. This article reviews the recommendations and available evidence of chest physiotherapy, mainly manual and instrumental techniques of bronchial drainage and physical exercise in children with primary ciliary dyskinesia.
La disquinesia ciliar primaria es una enfermedad autosómica recesiva rara con compromiso del drenaje mucociliar. Entre las estrategias terapéuticas no farmacológicas más comúnmente recomendadas se encuentra las técnicas de drenaje de secreciones. Sin embargo, la evidencia del uso y efectividad de estas técnicas es reducida y generalmente se basan en evidencia extrapolada de la fibrosis quística. Este artículo revisa las recomendaciones y la evidencia disponible de la kinesiología respiratoria, principalmente las técnicas manuales e instrumentales de drenaje bronquial y el ejercicio físico en niños con disquinesia ciliar primaria.
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Humanos , Lactente , Criança , Adulto , Pneumonia/terapia , Terapia Respiratória/métodos , Síndrome de Kartagener/diagnóstico , Modalidades de Fisioterapia , Exercício Físico/fisiologia , Drenagem/instrumentação , Secreções CorporaisRESUMO
BACKGROUND: Bronchiectasis is characterized by abnormal and permanent dilatation of the bronchi, caused mainly by the progression of inflammatory processes and loss of the ability to remove mucus. Techniques to clear the airways are essential for the treatment of these patients. In this study, we aimed to evaluate the acute effects of oscillatory PEP and thoracic compression on both the clearance of secretions and impedance of airways in subjects with bronchiectasis. METHODS: This was a randomized crossover single-blinded study that involved both subjects with bronchiectasis and healthy subjects evaluated by using an impulse oscillometry system, which assessed resistance at 5 Hz and resistance 20 Hz, reactance at 5 Hz, reactance area, and resonant frequency, before, after, and 30 min after oscillatory PEP, chest compression, or control sessions. Dry and total weights, adhesiveness, purulence of the expectorated secretions, the dyspnea scale score, the acceptability and tolerance scale score, pulse oximetry, and difficulty in expectoration were also assessed. RESULTS: The dry and total weights of secretions were higher after the use of the oscillatory PEP technique than those in a control session (P = .005 and P = .039, respectively). In the bronchiectasis group, there was a decrease after oscillatory PEP in total airway resistance (P = .04), peripheral resistance (P = .005), and reactance area (P = .001). After compression, there was a decrease in peripheral resistance Hz (P = .001) and reactance area (P = .001). In the healthy group, there was an increase in resistance at 5 Hz (P = .02) after oscillatory PEP. There were no differences in acceptability and tolerance, dyspnea, and oxygen saturation. CONCLUSIONS: The oscillatory PEP technique was effective for the removal of secretions and in decreasing total and peripheral respiratory system resistance; thoracic compression had comparable positive effects on the peripheral resistance. Both techniques were safe and well tolerated by the subjects with bronchiectasis. ClinicalTrials.gov registration NCT02509637.).
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Bronquiectasia , Oscilação da Parede Torácica/métodos , Impedância Elétrica , Depuração Mucociliar , Testes de Função Respiratória/métodos , Bronquiectasia/diagnóstico , Bronquiectasia/fisiopatologia , Bronquiectasia/terapia , Estudos Cross-Over , Drenagem Postural/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modalidades de Fisioterapia , Terapia Respiratória/métodos , Resultado do TratamentoRESUMO
OBJECTIVE: To evaluate the effects of the use of respiratory physiotherapy in children admitted with acute viral bronchiolitis (AVB). METHODS: A literature review was done searching the Pubmed, LILACS, PEDro, and Scielo databases. The following key words were used: bronchiolitis, physiotherapy, techniques, physical therapy, and chest physiotherapy. Both controlled and uncontrolled clinical trials, without limits as to date, were selected. RESULTS: Fifteen articles were included and the use of different techniques of respiratory physiotherapy showed positive results in eight studies. Most (11) were controlled clinical trials, and only two had a double-blind design. Of the 14 studies with a control group, in six this group was submitted to nasopharyngeal aspiration. The most widely used techniques were manual vibration and postural drainage (eight studies), and then tapping/percussion (seven studied). The maneuvers considered as current, e.g., prolonged slow expiration, expiratory flow acceleration, and rhinopharyngeal retrograde clearance, were used in four, four, and two studies, respectively. CONCLUSIONS: The use of respiratory physiotherapy in children with AVB remains controversial. The heterogeneity of techniques evaluated in the studies limits the interpretation of efficacy, although its use was considered safe. Recent findings indicating a reduction in the length of the hospital stay remain to be confirmed.
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Bronquiolite Viral/terapia , Terapia Respiratória/métodos , Criança , Hospitalização , Humanos , Terapia Respiratória/efeitos adversos , Resultado do TratamentoRESUMO
Chest physical therapy techniques are essential in order to reduce the frequency of recurrent pulmonary infections that progressively affect lung function in cystic fibrosis patients. Recently, ELTGOL (L'Expiration Lente Totale Glotte Ouverte en décubitus Latéral) emerged as an inexpensive and easy to perform therapeutic option. The aim of this study was to compare the acute effects of ELTGOL and the Flutter valve in stable adult patients with cystic fibrosis. [Subjects and Methods] This was a randomized, crossover study with a sample of cystic fibrosis outpatients. The subjects underwent two protocols (Flutter Valve and ELTGOL interventions, referred to as ELTGOL and FLUTTER) in a randomized order with a one-week washout interval between them. The main outcomes were pulmonary function variables and expectorated sputum dry weight. [Results] ELTGOL cleared 0.34â g more of secretions than FLUTTER (95% CI 0.11 to 0.57). When comparing the physiological effects of ELTGOL and FLUTTER, the first was superior in improving airway resistance (-0.51 cmH2O/L/s; 95% CI -0.88 to -0.14) and airway conductance (0.016 L/s/cmH2O; 95% CI 0.008 to 0.023). [Conclusion] ELTGOL promoted higher secretion removal and improvement in airway resistance and conductance than the Flutter valve. These techniques were equivalent in reducing the pulmonary hyperinflation and air trapping in cystic fibrosis patients.
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BACKGROUND: Septic shock presents as a continuum of infectious events, generating tissue hypoxia and hypovolemia, and increased oxidative stress. Chest physiotherapy helps reduce secretion, improving dynamic and static compliance, as well as improving secretion clearance and preventing pulmonary complications. The purpose of this study was to evaluate the immediate effect of chest physiotherapy on hemodynamic, metabolic, inflammatory, and oxidative stress parameters in subjects in septic shock. METHODS: We conducted a quasi-experimental study in 30 subjects in septic shock, who underwent chest physiotherapy, without associated heart diseases and with vasopressors < 0.5 µg/kg/min. Venous and arterial blood gases, clinical and hemodynamic data, inflammatory data, lactate, and oxidative stress were evaluated before and 15 min after physiotherapy. RESULTS: Thirty subjects with a mean age of 61.8 ± 15.9 y and Sequential Organ Failure Assessment of 8 (range 6-10) were included. Chest physiotherapy caused a normalization of pH (P = .046) and P(aCO2) (P = .008); reduction of lactate (P = .001); and an increase in P(aO2) (P = .03), arterial oxygen saturation (P = .02), and P(aO2)/F(IO2) (P = .034), 15 min after it was applied. CONCLUSIONS: The results indicate that chest physiotherapy has immediate effects, improving oxygenation and reducing lactate and oxidative damage in subjects in septic shock. However, it does not cause alterations in the inflammatory and hemodynamic parameters.
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Modalidades de Fisioterapia , Choque Séptico/fisiopatologia , Choque Séptico/terapia , Idoso , Pressão Sanguínea , Dióxido de Carbono/sangue , Feminino , Frequência Cardíaca , Humanos , Concentração de Íons de Hidrogênio , Ácido Láctico/sangue , Masculino , Pessoa de Meia-Idade , Óxido Nítrico/sangue , Oxigênio/sangue , Pressão Parcial , Taxa Respiratória , Sucção , Substâncias Reativas com Ácido Tiobarbitúrico/metabolismo , Tórax , Fatores de Tempo , Fator de Crescimento Transformador beta/sangue , Vibração/uso terapêuticoRESUMO
AIM: To evaluate the effectiveness of chest physiotherapy (CPT), which provides slow and long expiratory flow and assisted cough techniques, in infants receiving outpatient care for acute wheezing episodes. METHODS: Forty-eight infants with moderate acute wheezing episodes were randomised to receive either salbutamol MDI with CPT (n = 25) or without CPT (n = 23). The clinical score and SpO2 levels were recorded, before and after treatment, in a blinded design. The primary outcome was discharge after the first hour of treatment: clinical score ≤5/12 and SpO2 ≥ 93%. Secondary outcomes were the number of admissions to hospital after the second hour, use of oral corticosteroid bursts and admissions to hospital on day seven. RESULTS: There were no differences between children with and without CPT in discharge rate (92% vs. 87%), clinical score (median [IQR]: 2.8 [2.2-3.3] vs. 3.4 [2.8-4.1]) and SpO2 = (96.4 [95.7-97.1] vs. 96.0 [94.9-96.5]) after the first hour of treatment or in the number of hospital admissions after the second hour. No differences were observed at days seven and 28 following treatment. CONCLUSION: There was no evidence of clinical benefits from these specific CPT techniques for infants receiving outpatient care for acute wheezing episodes.
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Albuterol/uso terapêutico , Assistência Ambulatorial/métodos , Broncodilatadores/uso terapêutico , Modalidades de Fisioterapia , Sons Respiratórios , Doenças Respiratórias/terapia , Doença Aguda , Feminino , Humanos , Lactente , Modelos Logísticos , Masculino , Método Simples-Cego , Resultado do TratamentoRESUMO
Objetivo: Avaliar a importância da fisioterapia respiratória nos cuidados intensivos neonatais, por meio dos trabalhos já publicados na literatura. Métodos: Fontes de dados pesquisadas: Medline, Cochrane Library, LILACS, SciELO. As palavras-chave utilizadas foram neonatos, fisioterapia respiratória, remoção de secreções, hipoxemia e bradicardia. Resultados: A atuação da fisioterapia respiratória foi avaliada entre os cuidados intensivos neonatais, bem como os efeitos da aplicação de suas técnicas. Tem sido aceito que a fisioterapia ajuda na prevenção de complicações respiratórias (diminuição da ventilação e/ou perfusão, obstrução das vias aéreas e aumento do trabalho respiratório) porém, devido à existência de trabalhos com diferentes metodologias e realizados em décadas diferentes, torna-se difícil fazer uma comparação dos seus resultados e, dessa forma, apresentar evidências sobre os efeitos da aplicação das técnicas fisioterapêuticas. Conclusões: A fisioterapia respiratória parece ter um papel importante nos cuidados intensivos neonatais, mas devido à escassez de trabalhos na área se torna difícil a comprovação de seus benefícios.
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Humanos , Recém-Nascido , Bradicardia/etiologia , Bradicardia/terapia , Fenômenos Fisiológicos Respiratórios , Modalidades de Fisioterapia , Recém-Nascido/fisiologia , Secreções CorporaisRESUMO
OBJETIVO: Realizar uma revisão da literatura sobre os mecanismos, diagnóstico e tratamento das atelectasias pulmonares em pediatria. MÉTODOS:Efetuou-se uma pesquisa nos bancos de dados eletrônicos Medline e Scielo com os critérios de inclusão: artigos publicados entre os anos de 1960 e 2007, que abordassem a etiologia, fisiopatologia, conseqüências funcionais, avaliação, prevenção, tratamento e complicações das atelectasias pulmonares em pediatria. Palavras-chave: atelectasis, children, pediatrics, mucus plugs, chest physiotherapy; atelectasias, criança, pediatria, fisioterapia respiratória, secreção brônquica. Utilizou-se o escore de Sackett DL, 1989 para a classificação do nível de evidência dos artigos encontrados. RESULTADOS:Foram analisados 45 artigos sobre atelectasias pulmonares, sendo 17 artigos em pediatria. Dos artigos com pacientes pediátricos, 13 estudos com série de casos clínicos, três artigos de revisão da literatura e um relato de caso, demonstrando que poucos artigos abordando atelectasias em pediatria foram publicados no período da pesquisa e que o nível de evidência dos artigos existentes são D e E. CONCLUSÃO: Poucos estudos clínicos foram realizados atualmente para identificar o tratamento mais eficaz para a resolução das atelectasias em pediatria. Embora a prática clínica tenha evoluído no tratamento das mesmas, com o aperfeiçoamento das técnicas de broncoscopia e da fisioterapia respiratória existe a necessidade da realização de estudos clínicos randomizados nesta área.
OBJECTIVE: To review the literature about mechanisms, diagnosis and treatment of atelectasis in the pediatric patient. METHODS: An electronic data search was carried out in Medline and Scielo using the following inclusion criteria for articles published between 1960 and 2007 about: atelectasis etiology, physiopathology, functional consequences, evaluation, prevention, treatment and complications, in pediatrics. The used key words were atelectasis, children, pediatrics, mucus plugs, chest physiotherapy; RESULTS: 45 pulmonary atelectasis articles were analyzed, 17 of them in pediatrics. Of the pediatric, 13 were case series, 3 literature reviews and one a case report. This demonstrates that there were few articles on atelectasis during the reviewed period and that these articles were at the D and E evidence level. CONCLUSION: No clinical trials were performed to identify s the most efficient treatment for atelectasis in the pediatric patient. Although clinical practice for treatment of atelectasis has evolved, mostly due to improvement of bronchoscopy and chest physiotherapy techniques, there is still a need to perform randomized clinical trials to address treatment of atelectasis in the pediatric patient.
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Criança , Humanos , Atelectasia Pulmonar , Ensaios Clínicos como Assunto/estatística & dados numéricos , Medicina Baseada em Evidências/normas , Atelectasia Pulmonar/diagnóstico , Atelectasia Pulmonar/etiologia , Atelectasia Pulmonar/fisiopatologia , Atelectasia Pulmonar/prevenção & controleRESUMO
The objective of the present study was to evaluate breathing pattern, thoracoabdominal motion and muscular activity during three breathing exercises: diaphragmatic breathing (DB), flow-oriented (Triflo II) incentive spirometry and volume-oriented (Voldyne) incentive spirometry. Seventeen healthy subjects (12 females, 5 males) aged 23 ± 5 years (mean ± SD) were studied. Calibrated respiratory inductive plethysmography was used to measure the following variables during rest (baseline) and breathing exercises: tidal volume (Vt), respiratory frequency (f), rib cage contribution to Vt (RC/Vt), inspiratory duty cycle (Ti/Ttot), and phase angle (PhAng). Sternocleidomastoid muscle activity was assessed by surface electromyography. Statistical analysis was performed by ANOVA and Tukey or Friedman and Wilcoxon tests, with the level of significance set at P < 0.05. Comparisons between baseline and breathing exercise periods showed a significant increase of Vt and PhAng during all exercises, a significant decrease of f during DB and Voldyne, a significant increase of Ti/Ttot during Voldyne, and no significant difference in RC/Vt. Comparisons among exercises revealed higher f and sternocleidomastoid activity during Triflo II (P < 0.05) with respect to DB and Voldyne, without a significant difference in Vt, Ti/Ttot, PhAng, or RC/Vt. Exercises changed the breathing pattern and increased PhAng, a variable of thoracoabdominal asynchrony, compared to baseline. The only difference between DB and Voldyne was a significant increase of Ti/Ttot compared to baseline. Triflo II was associated with higher f values and electromyographic activity of the sternocleidomastoid. In conclusion, DB and Voldyne showed similar results while Triflo II showed disadvantages compared to the other breathing exercises.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Exercícios Respiratórios , Diafragma/fisiologia , Mecânica Respiratória/fisiologia , Espirometria/métodos , Eletromiografia , Pletismografia , Espirometria/instrumentaçãoRESUMO
JUSTIFICATIVA E OBJETIVOS: A fisioterapia respiratória (FR) em pacientes submetidos a suporte ventilatório invasivo, atua diretamente no sistema ventilatório podendo alterar a mecânica pulmonar através da complacência pulmonar dinâmica (Cdyn) e da resistência do sistema respiratório (Rsr). Porém, as alterações descritas após a realização de FR permanecem controversas. O objetivo deste estudo foi avaliar as alterações da mecânica pulmonar em pacientes em ventilação mecânica invasiva (VMI). MÉTODO: Foi realizado estudo prospectivo e aleatório, controlado do tipo cruzado, incluindo pacientes com mais de 48 horas em VMI. Os protocolos de fisioterapia respiratória (PF) e de aspiração traqueal isolada (PA) foram aleatorizados para a ordem de aplicação, com intervalo de 24 horas entre eles. Dados da mecânica pulmonar e das variáveis cardiorrespiratórias foram coletados antes da aplicação do protocolo, imediatamente após; 30 minutos e 120 minutos após a aplicação dos protocolos. RESULTADOS: Doze pacientes completaram o estudo. A pneumonia foi a causa mais comum de insuficiência respiratória (IRpA). Não houve diferença estatisticamente significativa entre os grupos em relação à Cdyn, volume de ar corrente (VAC) e volume-minuto (VM). A Rsr diminuiu de forma significativa imediatamente após (de 10,4 ± 3 cmH2O/L/seg para 8,9 ± 2 cmH2O/L/seg; p < 0,02), 30 minutos após (de 10,4 ± 3 cmH2O/L/seg para 9 ± 2 cmH2O/L/seg; p < 0,01) e 120 min após (de 10,4 ± 3 cmH2O/L/seg para 9 ± 2 cmH2O/L/seg; p < 0,03) a aplicação do protocolo de fisioterapia respiratória. Quando comparado com o protocolo de aspiração traqueal isolada foi significativamente menor nos momentos 30 (9 ± 2 cmH2O/L/seg versus 10,2 ± 2 cmH2O/L/seg; p < 0,04) e 120 minutos (9 ± 2 cmH2O/L/segundo versus 10,4 ± 3 cmH2O/L/seg; p < 0,04). CONCLUSÕES: O protocolo de fisioterapia respiratória foi eficaz na diminuição da Rsr quando comparado com o protocolo de aspiração. Essa diminuição manteve-se...
BACKGROUND AND OBJECTIVES: The chest physiotherapy (CP) in patients submitted to invasive support ventilation acts directly in the breathing system, and it could alter the lung mechanics through the dynamic lung compliance (DynC) and resistance of the breathing system (Rbs). However the alterations after the accomplishment of CP are still controversy. The objective of this study was to evaluate the alterations of the lung mechanics in patients in invasive mechanical ventilation (IMV). METHODS: It was a prospective, randomized, and controlled and crossover study, with patient with more than 48 hours in IMV. The protocol of chest physiotherapy and isolated tracheal aspiration they were randomized for the application order with a window of 24 hours among them. Data of lung mechanics and its varied cardiorespiratory were collected moments before the protocol, immediately after the application of the protocol, 30 minutes and 120 minutes after the application of the protocols. RESULTS: Twelve patients completed the study. Pneumonia was the mean cause respiratory failure (RF). There was not statistical difference among the groups in relation to Cdyn, volume tidal (Vt) and volume minute (Ve). Rbs decreased in a significant way immediately after (of 10.4 ± 3 cmH2O/L/seg for 8.9 ± 2 cmH2O/L/seg; p < 0.02), 30 minutes after (of 10.4 ± 3 cmH2O/L/seg for 9 ± 2 cmH2O/L/seg; p < 0.01) and 120 minutes after (of 10.4 ± 3 cmH2O/L/seg for 9 ± 2 cmH2O/L/seg; p < 0.03) application the protocol of chest physiotherapy. When compared with the protocol of isolated tracheal aspiration it was significantly smaller in the 30 (9 ± 2 cmH2O/L/seg versus10.2 ± 2 cmH2O/L/seg; p < 0.04) and 120 minutes (9 ± 2 cmH2O/L/seg versus 10.4 ± 3 cmH2O/L/seg; p < 0.04). CONCLUSIONS: The protocol of chest physiotherapy was effective in the decrease of Rsr when compared with the aspiration protocol. That decrease was maintained for two hours after its application, what did not happen...